The recognition of an association between trigeminal neuralgia and ipsilateral hemifacial spasm has been delayed by confusion over the nomenclature of the two conditions. Three patients are presented who had facial pain associated with hemifacial spasm. The findings on investigation of these patients, and an analysis of the literature, suggests that the combination is almost inevitably associated with pathological processes in the posterior fossa, particularly anomalous, ectatic or aneurysmal blood vessels.